When it comes to Shabbos and the permissibility of injections and associated activity, not everyone has full clarity. This topic applies to insulin-dependent diabetics, people who require short-term growth hormone shots, women who take Ovidrel or Cetrotide (cetrorelix) for fertility issues, girls with Turner Syndrome, and a number of others, too. What follows is a brief discussion of the different injections and their associate halachos.
Injection Types
There are: subcutaneous (under the skin), intramuscular (into the muscle), and intravenous (into the vein) injections.
A subcutaneous injection does not necessarily cause bleeding. It is thus considered no different than other types of medicine and is permitted for a sick person. If one is not sick but is in pain, he may ask a non-Jew to administer it.
For a choleh she’ein bo sakanah, a sick person who is not deathly ill, it is permitted to inject with a subcutaneous or intramuscular injection, but not an intravenous injection. That may be different for Sephardim, however. Rav Bentzion Abba Shaul, zt’l, in his Ohr L’Tzion (Vol. II #20), ruled that an intravenous injection is a melachah she’aina tzrichah l’gufah, a violation that is not for the original purpose in the Mishkan. Generally speaking, an intravenous injection requires taking out a little bit of blood to ensure that it is in the correct place.
There is a debate among the Rishonim as to what melachah is involved when taking out blood. Rashi (Shabbos 107a) states that it is on account of shochet. Tosfos, Rashba, Ritva, and Meiri agree with Rashi. The Rambam, on the other hand (Hilchos Shabbos 8:7) holds that it is on account of mefareik, a subcategory of dosh. The difference would be (see Biur Halachah 316:8 Ha’chovel) that according to the Rambam, the amount of blood taken out that would be a Torah violation would be the volume of a fig. According to Rashi, it would be any amount. However, if there is a purpose for the lesser amount, then some may consider it a violation even according to the Rambam.
Preparing The Needle Or Syringe
Many types of daily injections require putting together the needle. There are needle heads that one must screw onto the insulin pen. Many poskim consider this act a possible violation of boneh or makeh b’patish, a final act. Makeh b’patish means, when literally translated, “the strike of a hammer.” However, in general it refers to an act of completion. Any act of perfecting an object or rendering it fit for use may be considered a violation of the melachah of makeh b’patish. Rav Shlomo Zalman Auerbach, zt’l (Shulchan Shlomo Refuah Vol. I p. 54), writes that if one throws out the needle head afterward, then one may be lenient if it is necessary. The Chazon Ish, however, forbade it even if the needle head is thrown out.
There are readings of Rav Auerbach (ibid p. 56) that may permit it with the insulin pens that are currently used, but one must consult with one’s own rav or posek.
A solution to this problem would be to affix the needle head onto the pen before Shabbos.
Mixing Medicines On Shabbos
There are some injections that need to be mixed together before use, and delaying that daily shot until motzaei Shabbos can jeopardize the treatment. For example, in fertility treatment, missing a dose of Cetrotide (cetrorelix) or taking it late lowers the chance of successful egg retrieval. When mixing on Shabbos, a shinui may be necessary in order to avoid certain halachic complications.
Alcohol Swabbing
There is a longstanding debate between poskim as to whether one may use baby wipes on Shabbos. The issue is that of a possible violation of sechitah, in this case, part of the melachah of laundering.
But what about the use of an alcohol swab to clean injection sites? Is there a difference between baby wipes and alcohol swabs in this regard? Before acting on anything, please consult with your own doctor and your own rav or posek.
Various health organizations, including the WHO, United Kingdom’s Department of Health, and Australia’s Department of Health, have stated that if the skin is visibly clean, disinfecting the skin (or alcohol swabbing) is not necessary and does not actually reduce infection. On the other hand, Canada’s Public Health Agency advises the practice of cleaning the skin with a suitable antiseptic solution prior to vaccination or injection.
Alcohol swabs are made of cotton, and one is squeezing out the alcohol onto the injection site when cleaning that site. Unless the skin is visibly dirty, because of the ongoing debate about whether the continued use of alcohol swabbing is clinically necessary and effective for routine subcutaneous injections or vaccinations, some have suggested that people can avoid swabbing the site on Shabbos.
May Hashem send a complete refuah to all who are sick. We beg that it be speedily, k’heref ayin! Amen.
The author can be reached at Yairhoffman2@gmail.com. Read more of Rabbi Hoffman’s articles at 5TJT.com.
